| NPI | 1619777653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA LIDELLE HARE Medical Director 706-847-0826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2025-03-18 |
| Last Update Date | 2025-03-18 |